Although we often speak of pain being multifactorial , we still tend to assume that just one of those factors is the specific cause of pain, and the others — sleep loss, stress, etc — are only piling on , making a bad situation worse. That picture may be wrong: It may crop up only with an unholy combination of many factors.

The idea of pain that truly has no specific cause is something more patients probably need to consider. Pain without no one cause is a good news scenario in the sense that it might be treated by relieving enough of the contributing factors… but bad news in the sense that it may be like fighting a hydra. Muscle tissue is everywhere — our most massive biological system — and its subtler hijinks can cause a lot of discomfort without giving itself away.

No one has any doubt about the cause of pain when they get a massive calf or foot cramp, but not all cramps are so obvious, and there are other types of insidious, uncomfortable muscle contractions. Using just wide brush for now, the types of unwanted contractions that cause the most trouble without being easy to diagnose are cramps, dystonia, spasticity.

Trying to understand pain when there is no obvious explanation.

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The biology and treatment of unwanted muscle contractions. Anything that hurts inside the body — anything deeper than skin — is harder for the brain to locate. Despite the fact that this phenomenon is well known, it still results in an amazing amount of medical barking up the wrong tree. For instance, both of the examples at the beginning of this article were cases where referred pain fooled doctors — in both cases, the pain was caused by a trigger point in a nearby muscle, not by vital organs.

The doctors simply looked in the wrong place! How long can you last? Within an hour you will probably be in severe pain. But we seem to be wired to avoid stagnancy, probably because every cell in our body depends on nearly constant movement to survive. The exact mechanism of pain is probably nerve endings that detect tension on cartilage, ligaments, and tendons, and which in turn is interpreted by the brain as a surprisingly serious threat.

It can be caused by surprisingly subtle postural stresses like from poor ergonomics , or anything that deprives tissue of full movement. This is may be the main causes of neck cricks , for instance, and scads of other miscellaneous aches and pains.

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Neutrophils are defender cells that are supposed to destroy bacteria that invade wounds, a normal part of the inflammatory response to injury. Bizarrely, neutrophils go to work even when the wound is sterile, not open to the outside world. Like an overzealous police force with nothing better to do, they also attack a common cellular organ, mitochondria, whenever it is spilled from cells by injury. Mitochondria are actually honoured symbiotic guests that convert our food to energy for us. Normally we live out our lives in perfect harmony with mitochondria, biological BFFs.

Inflammation often seems excessive because it is, because every trauma causes pain that is too loud for too long, because a significant portion of the inflammation is due to this SNAFU immune system policy of attacking mitochondria. There are many perverse sources of pain in pathology, but this one really stands out as being particularly ridiculous and unfair. It does have one practical implication: For more information, see Why Does Pain Hurt?

How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain. Chronic, subtle, systemic inflammation is a possible factor in stubborn musculoskeletal pain. The greatest culprit is metabolic syndrome: See Chronic, Subtle, Systemic Inflammation: A possible insidious cause of mysterious chronic pain.

This is probably not one disease. For an insane amount of information, see my book on this topic: Most pain sensitization is simply a reaction to pain itself , a more-or-less normal, common, and reversible reaction to chronic pain. The example of this is complex regional pain syndrome, which causes extreme pain, usually in a limb, and usually following some relatively minor tissue insult like an insect bite, a minor cut, or a small fracture. Many times in my career I have become quite convinced that a patient had to be suffering from some lesser form of CRPS, awful but not enough to clinch a CRPS diagnosis.

An irritated spinal cord — usually irritated by being slightly pinched by a narrow spinal canal — can cause an astonishing variety of problems, including pain, without ever clearly giving itself away.

Symptoms can be in virtually any location in the body, if the location of the trouble is high in the spine. This can go on for years, bad enough to cause pain but never bad enough to be easily diagnosable. Sometimes an artery gets narrowed or pinched off and causes serious pain. But it should be an easy diagnosis: A patient had sciatica-like leg pain for thirty-five years and was misdiagnosed many times until finally getting not only a definitive diagnosis but a cure.

Not even a difficult a diagnosis in the end, really. There were some pretty glaring clues there that got ignored by a lot of people who should have known better. But not only was he misdiagnosed many times over more than three decades, he was misdiagnosed fashionably: This carried on right up to and including the present day fascination with psychosocial factors and sensitization which served him no better than any of the other paradigms had.

This, of course, had been explained away to him more recently by current research and evidence-based thinking on central sensitization and pain. The authors thoughtfully explore the implications of this rather shameful episode. Good diagnostic skills are never out of fashion. Hypermobility spectrum disorders HSD are a group of conditions defined by joint hypermobility — unexplained joint looseness. HSD is a bucket diagnosis for people with symptomatic hypermobility, but without a clear diagnosis of a connective tissue disorder that would explain it, like Ehlers—Danlos syndrome or Marfan syndrome.

Most connective tissue disorders are relatively obvious. Ehlers—Danlos syndrome EDS is a closely related group of conditions with known genetic causes that includes hypermobility along with lax and fragile tissues that injure easily and heal poorly especially skin , with many consequences. They tend to be preoccupied with more obvious and dire cases. There is not a single supplement or anti-inflammatory superfood that is clearly beneficial for any common kind of pain, but there are a couple nutritional deficiencies that stand out as significant, legitimate suspects in many chronic pain cases.

Pain may be the only clear symptom of either one. Vitamin D deficiency is on the firmest ground.

It is probably more common than once suspected — at least 1 in 20 people in the lowest estimates, 13 and possibly many more. For more information, see Vitamin D for Pain. Magnesium deficiency is also a suspected factor in chronic pain, especially migraines. Ironically, magnesium in a clinical setting is known to induce cramping and severe muscular pain, so none of this biology straightforward! The first sign of syphilis is a lesion that is often minor and easily missed: The second stage consists a few weeks of malaise and rashes. The disease then goes dormant to some degree, for years, or forever, but in some people it will develop into the final stage, which is where the pain comes in, one of a great variety of possible symptoms.

Some patients with unexplained chronic widespread pain fibromyalgia probably have syphilis. Biology is destiny, and this condition is a really good example of it.

Does your body really start falling apart in your 30s?

How many people out there are in that multi-decade period of wondering why they get so sore so easily, before finally being diagnosed with FSHD? The autoimmune diseases are a huge class of pathologies that can cause essentially any non-specific symptoms for a long time before diagnosis. These are conditions like lupus, rheumatoid arthritis, celiac disease, inflammatory back pain spondyloarthritis, a common cause of the phenomenon of morning back pain , and many, many more.

Lupus is one of the most common and notoriously unpredictable and slow to develop. Some people with a variety of weird aches and pains and other symptoms are going to end up getting diagnosed with lupus eventually, but it can take literally years for the situation to clarify.

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So it's another autoimmune disease, but it's one that is particularly common, serious, and prone to causing pain before diagnosis. It definitely does not cause primarily pain in every patient; the classic onset of multiple sclerosis is more blatantly neurological in character tingling, numbness, and sensory disturbances. But some patients definitely start with pain, and spasm is the primary mechanism. One particularly good and sinister example: Although the feeling of constriction is the classic symptom, many patients also just experience widespread and erratic pain in the chest wall, probably from erratic, isolated painful contractions.

It will probably reveal itself sooner rather than later. But there is definitely potential for a period of unexplained pain. Lymphoma is a cancer of the infection-fighting cells of the immune system, cells in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body. These cells grow out of control. The swollen nodes are not painful, and pain is not a classic symptom… but it is a possible, depending on where tumours are forming and what they are pressing on, and possibly because of increased systemic inflammation.

Reserve a few minutes to read this: But please, doctors and anyone responsible for diagnosing: Other kinds of pain are possible too, but those are usually more distinctive and readily identified as a drug side effect. Joint and muscle pain are easily mistaken for the ordinary aches and pains of aging, removing suspicion from the drugs that are actually causing them.

Some of the usual suspects are:. Some of these may actually be innocent, others almost certainly do cause trouble: The bisphosphonates — On January 7, , the U. This medication has almost certainly explained some otherwise inexplicable pain in some of my patients over the years! Statins are important and widely used drugs, and their deleterious effect on muscle is widely considered a diagnosable condition: And yet there is also confusion and controversy about the prevalence of statin myalgia. There might also be some tricky X-factors, like vitamin D deficiency, which seems to be linked to statin myalgia.

Fortunately, for the genuinely statin intolerant — and you probably do exist! Opioids are, of course, the cause of an enormous amount of misery and controversy right now. Endorphin production, for instance, will drop. This can have disastrous consequences when you stop taking the drugs, resulting in worse pain than ever.

The "your body falls apart in your 30s" idea probably also has something to do with that particular life stage, Bond University sports scientist Peter Reaburn says. Pregnancy, too, can make women more susceptible to injury, even after they've given birth, Dr Fell says. Pregnancy elicits release of a hormone called relaxin, which among other effects causes ligaments to become more stretchy. The third key factor is our fast-twitch muscle fibres, which are used for rapid movements like sprinting or jumping, also shrink — even in lifelong sprint athletes.

Feel like you're reaching for the deep heat more often? Try resistance exercises to prevent injury. Just remember to up your protein intake to give muscles the materials they need to knit back together, he advises. If you have inside knowledge of a topic in the news, contact the ABC. ABC teams share the story behind the story and insights into the making of digital, TV and radio content.

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